Provider Demographics
NPI:1780732594
Name:TOTAL LYMPHEDEMA CARE INC
Entity type:Organization
Organization Name:TOTAL LYMPHEDEMA CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:YZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-438-5655
Mailing Address - Street 1:275 NW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4061
Mailing Address - Country:US
Mailing Address - Phone:954-438-5655
Mailing Address - Fax:
Practice Address - Street 1:275 NW 107TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4061
Practice Address - Country:US
Practice Address - Phone:954-438-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF385OtherMEDICARE LEGACY
FLAF385Medicare PIN